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  1. 1. PEDIATRIC DEPARTMENT PRESENTED BY: Deepali P.Liman Vineeth Thomas (Pharm.d intern)
  2. 2. Summary of activities chart Activity Participation Ward round Attended from 1/6 /2015 to 2/7/2015 Number of cases followed 11 Number of case solved in SOAP format 4 Number of drug information provided 6 Number of DI monitored 1 Number of history interview taken 1 Assignment from preceptor and solved 3 Assignments from physician 7 Clinical trials participitation Observed vaccination, clinical trial study, SAE form report documentation Number of Dose division done 6
  3. 3. Case presentation on Rheumatic Fever and Rheumatic Heart Disease • 13 years male patient • Wt : 25.46 kg • Came with c/o swelling over hands since 1 ½ months, mild non-progressive chest pain since 2 months ( on and off ), breathlessness on exertion on walking 2 stairs • Past medical history: child was diagnosed to have RA with RHD since 11 years of age (14/3/2014), child was also admitted for 7days & diagnosed of RA with RHD and moderate mitral regurgitation, bronchitis (3/6/15), child was on regular OPD follow up 19/6/15 • Prescription medication history: • Inj pencom 1.2 millions units every 21 days • T.omnacortil • T. aspirin • T.claven • T.vamol
  4. 4. Objective Physical examination Febrile, pallor, oedema, swelling, redness over carpometacarpal joints of both the hands Vitals HR: 90/min RR:24/min BP:100/67mmHg CVS S1S2 heard, S2 loud, grade 3 pansystolic murmur + RS AEBE clear CNS Conscious oriented
  5. 5. Laboratory investigations Lab reports 1st day 2nd day ESR 125 mm/hr 127 mm/hr CRP 23.66mg/dl Neutrophils 56 % Lymphocytes 34 % Monocytes 6 % Hb 10.1 gm/dl Specialiased diagnostic tests Echo-cardiography and doppler report : RHD, mild MR, trivial AR, mild PAH, normal LA function
  6. 6. ASSESSMENT • Subjective & objective data correlates that child was diagnosed with Rheumatic fever with Rheumatic Heart Disease PLAN Goals of therapy • Diagnosis and management of rheumatic fever • Management of cardiac complications of rheumatic fever • Provide prophylaxis treatment of RHD • Provide patient counselling
  7. 7. Medication given Brand name Generic name Dose Frequency Start date Stop date Indication T. Disprin Aspirin 350 mg 1-1-1 23/6 25/6 To decrease inflammation in rheumatic fever T. Pan Pantopraz ole 40mg 1-1-1 23/6 25/6 To protect the GI lining, to decrease acid secretion Inj. Pencom (IM) Benzathin penicillin G 1.2 lakhs units 1-0-0 23/6 23/6 Secodary prophylaxis treatment for rheumatic fever and RHD
  8. 8. Standard treatment for Rheumatic fever & Rheumatic Heart disease
  9. 9. Patient counselling